(Near) Drownings

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Transcript of (Near) Drownings

Courtney Woods, MD PGY1Emergency MedicineEmory University SOMDrownings and Near DrowningReview epidemiology of Drowning & Near DrowningDiscuss PathophysiologyDiscuss patient presentationDiscuss Initial ED ManagementDiscuss key players to involveDiscuss final DispositionObjectives"When you're drowning, you don't say 'I would be incredibly pleased if someone would have the foresight to notice me drowning and come and help me,' you just scream." John LennonEpidemiologyPathophysiologyInvolved Systems

2nd leading cause of death: child <4yrs6th leading cause accidental deathmore common in rural and southern areasBimodal age distributionboys 4x > girls (submersion)boys 12x > girls (boating)girls > boys (bathtub)Definition: process resulting in primary respiratory impairment from submersion in liquid mediumInvoluntary LaryngospasmInvoluntary GaspInability to OxygenateLiquid in OropharphynxLaryngospasm ReleaseInitial Breath HoldingParasympathetic ResponseCO2 retentionO2 DepletionHyperventilationLiquid AspirationFurther HypoxemiaPulmonary Effects1-3 mL/kg fluid: impaired gas exchangePulmonary vasoconstriction/hypertensionFresh WaterHypOtonicDisrupts SurfactantSalt WaterHypERtonicSurfactant washoutFluid-induced BronchospasmAspiration VomitousPostobstructive Pulmonary EdemaHypoxic Neuronal InjuryARDSCardiovascular EffectsPERMANENT2 mins - LOC4-6 mins - Irreversible brain damagetissue hypoxia & ischemiaSecondary InjuryReperfusion, Sustained Acidosis, Cerebral Edema, Hyperglycemia, Release Excitatory Neurotransmitters, Seizures, Hypotension, Impaired cerebral autoregulationAutonomic Instability (Diencephalic/Hypothalamic Storm)SeizuresCNS EffectsCall from EMS - ETA 20 minutesCase Presentation4-year-old white male weighing 20 kilos was called in by EMS over the radio after being found down in a lake. The child was in good health until he fell into a fresh water lake while bird counting with his father. He was unaccounted for approx. 15-20 minutes until his body was found floating face down in the water. He was immediately pulled out and basic life support was started.What needs to be done in preparation for this patient in the ED?

EXPLICIT DISCHARGE INSTRUCTIONS & FOLLOW-UPReturn to ED fordyspnea, cough, feverF/u with PMD in 1-2 daysBounceCDU AdmissionsAdmissonsDischarge HomeSummary“He was swimming in a sea of other people’s expectations. Men had drowned in seas like that.” Robert Jordan, New SpringSUMMARYHealth, United States 1996-97 and Injury Chartbook. DHHS Publication No (PHS) 96-1232. US Department of Health and Human Services. Hyattsville, Md: National Center for Health Statistics;. 1997.